The pain in Donald Barsalou’s left hand and wrist would not go away. It kept him up at night and brought to a halt the carpentry projects the South Hadley resident works on to keep him busy in his semi-retirement. Barsalou made an appointment to see a doctor about the pain, and in the meantime his right hand began to bother him, the ongoing pain worse than what he was experiencing in his left hand. He suspected the repetitive motion of his computer work as a management consultant and his carpentry projects were at the root of the problem.
Diagnosis: Carpal Tunnel Syndrome
Barsalou’s doctor diagnosed him with carpal tunnel syndrome (CTS), a condition in which pressure is placed on the median nerve, which supplies feeling to the hand and controls movement of the thumb and the first three fingers (but not the little finger). The median nerve and several tendons run from the forearm to the hand through a small space called the carpal tunnel. When the median nerve is compressed in the carpal tunnel, often from repetitive motion, it becomes inflamed and can cause symptoms such as numbness, tingling, muscle damage in the hand and fingers, and, as Barsalou can attest, intense pain. After receiving the diagnosis of CTS, Barsalou was referred to Dr. Pranay Parikh, a Baystate Medical Center surgeon who specializes in injuries and conditions of the hand and wrist.
“Mr. Barsalou is classic carpal tunnel syndrome case,” says Parikh. “He presented with CTS on both sides, and we were able to successfully treat him and quickly get him back to his normal activities.”
Parikh performed a minimally invasive procedure called an endoscopic carpal tunnel release on Barsalou’s right hand. Through a ½-inch incision in Barsalou’s wrist, Parikh inserted tiny camera and knife through a lighted endoscope (a pencil-thin tube). While observing the inside of Barsalou’s hand and wrist on a nearby monitor, Parikh cut the transverse carpal ligament to ease pressure on the compressed median nerve. His left hand was more complicated. In one open procedure, Parikh released the carpal ligament, resolved neuropathic pain in a couple of Barsalou’s fingers, and removed a growth from the palm of his hand.
“Patients undergoing the endoscopic procedure report less pain and a quicker return to normal activities than patients who have a traditional open CTS surgery. Patients can go home the day of surgery, shower the next day and have few, if any, restrictions on their activity. On the other hand, patients who have traditional open CTS surgery have more pain, a number of stitches, a splint to brace the thumb and wrist, and a up to a month-long wait until they resume regular activity,” says Dr. David Refermat.
“As a hand surgeon, carpal tunnel surgery is very gratifying because patients have a very rapid resolution of their troublesome symptoms and often can sleep through the night for the first time in years. For a relatively minor surgery the dividends in symptom relief and hand function are very significant. At Baystate we favor the minimally invasive endoscopic carpal tunnel technique since the recovery period is almost non-existent and there is no scar on the work surface of the palm.”
Bread and butter, and more
While carpal tunnel syndrome is a “bread and butter” issue for a hand surgeon, Parikh says Baystate Hand and Wrist Surgery offers comprehensive services for patients with acute and chronic injuries of the hand, wrist and upper extremities. Those services range from cutting-edge minimally invasive procedures like endoscopic carpal tunnel release—which means smaller incisions and faster recovery times—to more sophisticated and complex techniques such as microsurgical vascular and nerve reconstruction for more difficult problems.
Parikh, who completed a hand and microvascular surgery fellowship at the Curtis National Hand Center in Baltimore and has a special interest in treating congenital hand differences in children, is joined in the Baystate practice by Dr. David Refermat, who specializes in all areas of hand and wrist surgery for adults and children. Refermat completed a fellowship in hand microsurgery at Yale-New Haven Hospital.
“Our entire care team—fellowship-trained hand and wrist surgeons, musculoskeletal radiologists, clinical nurse specialists, hand therapists, and other caregivers—has one goal,” says Refermat, “to help restore and maximize mobility of the hand and wrist and improve quality of life.”
Out of the box
Hand and wrist surgery has historically been a “black box,” says Parikh. The field was initially developed by plastic surgeons, who bring a degree of flexibility to their medical practice. The hand and wrist are made up of many delicate parts and are often one of the most injured parts of the body. Parikh and Refermat, who are both plastic surgeons as well, take a broad approach to hand and wrist problems. While they care for patients with more routine issues such as fractures and dislocations, they also see patients with more complex needs, including arterial and venous problems of the hands, joint reconstruction, and tumor excision.
“The hand is amazing and rather unique in that it contains bones, blood vessels, tendons and nerves—all in a very tight package. When one or more of these structures is damaged by trauma or disease, the function of the entire hand is at risk. No two cases are the same, and our specialty often requires thinking outside of the box. We both very much enjoy the intellectual and technical challenges involved in these complex cases,” says Refermat.
With a broad, patient-centered approach to care, Baystate Hand and Wrist Surgery patients work with a dedicated team of specialized hand therapists following surgery. These professionals provide physical and occupational therapy for acute or chronic pain management, sensory re-education following a nerve injury, and desensitization following nerve injury or trauma. In addition, they design and implement home exercise programs to help patients increase their range of motion, dexterity and strength and train them to resume daily life skills.
For Donald Barsalou, the surgery was a godsend. “I felt good after the surgery,” says Barsalou, who is back to his building projects. “No pain at night, no braces, no hesitation. My wrists and hands are doing great, and I have no restrictions.”
Patients interested in learning more about Baystate hand and wrist surgery should call 413-794-5363.